Download Intravenous cannulation

Intravenous cannulation
What is IV cannulation?
• Intravenous cannulation is a technique in which a
cannula is placed inside a vein to provide venous
access.
• Venous access allows:
• sampling of blood
• administration of IV fluids and medications,
Cannula
• This device is
available in various
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gauges (16-24 G),
lengths (25-44 mm),
compositions, and
designs.
Cannula
Gauge
• 22 Gauge:
• 20 Gauge:
• 18 Gauge:
• 16 Gauge:
Size
0.8 mm
1.0 mm
1.2 mm
1.7 mm
Tips
• Routinely, use the smallest
size (largest gauge number)
of catheter if possible to
prevent damage to the
vessel intima
• In an emergency situation
use a large gauge catheter
to allow administration of
large volumes of fluid
quickly
Tips
• The superficial veins of the
upper extremities are
preferred to those of the
lower extremities for
peripheral venous access
• they interfere less with
patient mobility and pose a
lower risk for phlebitis.
Tips
• It is recommended to choose a
straight portion of a vein to
minimize the chance of hitting
valves.
• Use the patient’s nondominant arm (if possible)
• For prolonged courses of
therapy, it is recommended to
start distally and move
proximally as distal catheters
are replaced.
Indication
• Repeated blood sampling
• Intravenous administration of
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IV fluids
Medications
Chemotherapy
Nutritional support
Blood or blood products administration
Radiological contrast agents for computed tomography,
magnetic resonance imaging, or nuclear imaging
Contraindications
• No absolute contraindications to intravenous
cannulation exist
• Avoid peripheral venous access in an injured,
infected, or burned extremity if possible
Equipment
• Non-sterile gloves
• Tourniquet
• Antiseptic wipes
• 5-ml syringe
• Sterile gauze
• Cannula
• Saline
• Adhesive Plaster
Before the procedure
1. Introduce yourself to the patient. Explain the
procedure to the patient and gain informed
consent to continue
2. Make sure there is adequate light and that the
room is warm enough to encourage vasodilation
3. Make sure the patient is in a comfortable
position and place a pillow or a rolled towel
under the patient’s extended arm
4. The patient’s skin should be washed with soap
and water if visibly dirty
Before the procedure
5. If difficulty is encountered in
finding an appropriate vein, one
of the following techniques may
be used:
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Inspection of the opposite extremity
Opening and closing the fist
Using gravity (holding the arm down)
Gentle tapping or stroking of the site
Applying heat (warm towel/pack)
Technique
1. Apply tourniquet and select
the appropriate vein
2. Apply an antiseptic solution
with friction for 30-60
seconds, allow to air dry for
up. Once cleaned, do not
touch or re-palpate the skin
3. Remove the cannula from its
packaging and remove the
needle cover ensuring not to
touch the needle
4. Stretch the skin distally and
tell the patient to expect a
sharp scratch
Technique
5. Insert the needle, bevel
upwards at about 30
degrees
6. Advance the needle until a
flashback of blood is seen
in the hub at the back of
the cannula
7. Once this is seen, progress
the entire cannula a
further 2mm, then fix the
needle, advancing the rest
of the cannula into the
vein
Technique
5. Insert the needle, bevel
upwards at about 30
degrees
6. Advance the needle until a
flashback of blood is seen
in the hub at the back of
the cannula
7. Once this is seen, progress
the entire cannula a
further 2mm, then fix the
needle, advancing the rest
of the cannula into the
vein
Technique
8. Release the tourniquet,
apply pressure to the
vein at the tip of the
cannula and remove the
needle fully
9. Remove the cap from
the needle and put this
on the end of the
cannula
10. Carefully dispose of the
needle into the sharps
box
Technique
11. Check function by flushing
with saline. If there is any
resistance, if it causes any
pain, or you notice any
localized tissue swelling;
immediately stop flushing,
remove the cannula and
start again
12. Apply the plaster to the
cannula to fix it in place
13. Finally, ensure that the
patient is comfortable and
thank them
Complications
• Pain
• Failure to access the vein
• Blood stops flowing into the flashback chamber
• Arterial puncture
• Thrombophlebitis
• Hypersensitivity reaction
• Peripheral nerve palsy
• Skin and soft tissue necrosis
• When some irritant solutions leak into the tissue e.g.
chemotherapeutic agents
• More safely infused into a central vein
Complications
• Thrombophlebitis
Complications
• Thrombophlebitis
• Hypersensitivity reaction
• Peripheral nerve palsy
Complications
• Thrombophlebitis
• Hypersensitivity reaction
• Peripheral nerve palsy
• Skin and soft tissue necrosis
• When some irritant solutions leak into
the tissue e.g. chemotherapeutic
agents
• More safely infused into a central vein
Intravenous fluid
Indications
• Maintain or replace body store
• Restore acid abase balance
• Restore the volume of blood component
• Administer of medication
• Provide Nutrition
• Monitor CVP
Equipment
• Tray
• Sterile syringes
• Spirit swabs
• Drip stand
• Drip + set
Technique
• Introduce yourself to the patient.
• Check the patient’s name and the type of fluid to
be given
• Explain the procedure to the patient and gain
informed consent
• Prepare your equipment
• Assemble the tubing solution according to the
manufacturer’s instruction
Technique
• Let out the air from the tubing by letting some of
the fluids run down the tubing
• Close the drip set to prevent fluid from flowing
out
• Hang the bag in the drip stand
• Open the cannula and connect it to the drip
• Adjust the drips according to the appropriate
dose (X drops per minute)
• Check regularly to see that the fluid is dripping at
the same rate and that fluid is going in to the vein
properly and that the puncture site is not swollen.
Types Of IV Fluids
1. CRYSTALLOIDS
• Isotonic
• 0.9% Sodium Chloride (NS)
• Lactated Ringers
• Dextrose 5% in Water (D5W)
• Hypotonic
• 0.45% Sodium Chloride
• Hypertonic
• 5% Dextrose in NS
• 5% Dextrose in Lactated
Ringers
• 5% Dextrose in 0.45% ½ NS
• 10% Dextrose in water
2. COLLOIDS (plasma
expanders)
• Albumin
• Plasma Protein
fraction
• Dextran
• Hetastarch
Blood Transfusion
Indications
• Treatment of anaemia
• Treatment of coagulation, platelet disorders
• Treatment of hypovolemia
Before the procedure
• Two people to check details (name, blood group
and compatibility)
• Blood transfusion report form; Unit(s) of blood
• Patient with IV access and wrist ID band
• Sterile blood giving set
• Prepare adrenaline, antihistamine and
hydrocortisone beside the patient
• Warm the blood
Technique
• Introduce yourself to the patient
• Explain the procedure and indication
• Gain verbal consent
• Ensure patient has patent venous access by
running NS through
• Check equipment – Correct unit of blood and
blood giving set
• With a partner – check patient’s name, blood
group and number of units of blood to be given
Technique -2
• Put on gloves
• Attach unit of blood to giving set and run through
blood correctly emptying the air in the set
• Connect the blood giving set to cannula; Secure
the giving set and cannula with bandaging.
• Ensure blood is flowing and set at correct rate
• Inform nurses blood is running and to make sure
routine observations are made.
• If any reaction has occurred the nurse should stop
the transfusion and call the doctor on call
immediately
Calculating the rate
• Drip Rate (drop/min) =
Volume to be infused (ml) x Drop Factor (drp/ml)
Time (minutes)
Blood products
• Whole Blood
• Packed Cells
• Platelets
• Fresh Frozen Plasma (FFP)
• Cryoprecipitate
Complications
• A. Acute complications:
• Acute intravascular hemolysis
• Febrile non-hemolytic reactions
• Allergic reaction and anaphylaxis
• Septicemia
• Transfusion Related Acute Lung Injury (TRALI)
• Hypothermia (why? – How to avoid?)
• Volume overload
Complications
• B. Delayed complications
• Delayed haemolytic transfusion reaction
• Transfusion associated Graft versus Host disease
• Post Transfusion Purpura
• Citrate Intoxication and Hyperkalemia
• Infectivity-Hepatitis B & C, HIV, CMV, Syphilis
and malaria
Summary
• IV cannulation is a very common daily procedure
• Used to obtain blood samples, insert IV fluids,
medications, nutrients, and blood transfusion and blood
products
• Could be life-saving
• Should be performed following proper procedure
to avoid problems and complications